Bring On the Virtual Doctors

Last night I talked to my friend, a medical resident at an elite urban hospital. She called me on her walk home after a stressful day in the general medical wards. She had 17 patients with a wide range of problems: heart failure, emphysema, HIV, alcohol withdrawal, diabetes complications, even a man who had swallowed a handful of razor blades.

The last time we had talked, a month ago, she was working in the cardiac intensive care unit. That week she was juggling five patients, all with heart failure. She was literally running from one to the next to slow down the inevitable: They were all going to die soon, it was just a matter of when and how painfully. She was torn up by the thought, irrational but powerful, that every one of her decisions could cause one of them to die. (None did.)

Healthcare resources in the U.S. are getting thinner every day, and not only at big hospitals. Many forecasts predict a doctor shortage in the years to come. As one small sign of this sea change, last year my health insurer sent me an email recommending NowClinic, a website that connects you to a doctor with a webcam, ichat or phone. “Instead of making a trip to the clinic every time you’re sick, this service allows you to describe your symptoms to a doctor in real-time,” the email read. “The physician can then write you a prescription on the spot and have it filled at your choice of pharmacy.”

At first I was skeptical of the concept. I thought it sounded like a glorified WebMD and would ultimately be an ineffective way of cutting costs. How could a Skype chat be anything like the long-term, in-person relationship you have with your doctor?

But, but…who has long-term, in-person relationships with doctors these days? I certainly don’t. My doctor visits are rarely more than 15 minutes, and the only doctor I’ve known more than a year is my dentist. What’s more, do we know that a virtual visit is necessarily less meaningful than one IRL? A new report suggests to me that a virtual interaction might capture the essential ingredient of the doctor-patient relationship: empathy.

In the new study, published today in Molecular Psychiatry, researchers in Boston measured brain activity of 18 doctors while they interacted with an actress whom they believed was a real patient. First each doctor completed a 20-minute physical exam of the patient. Then they both went into a room with a brain scanner; the doctor rolled into the machine lying down while the patient sat outside of it, near the doctor’s feet. Mirrors inside of the scanner allowed the doctor to see the patient’s face.

The researchers placed a fake heat probe on the patient’s arm, and she pretended to wince in pain. On some trials, the doctors were told to press a button that they thought administered a pain medication, leading to visible relief on the patient’s face. On other trials, the doctors pressed a button that did nothing.

When the doctors thought they were treating the patient’s pain, their brains showed increased activation in the ventrolateral prefrontal cortex, a region also known to be activated during the expectation of pain relief, such as when taking a placebo drug. The study also found that activations in a region called the anterior cingulate cortex, involved in feeling reward, correlated with the doctors’ scores on a questionnaire about their own empathy skills.

I’m not convinced the study says anything profound about doctors. Had the researchers tested non-doctors instead, I doubt the responses would have been any different, as most of us feel empathy when seeing others of pain. Still, I think the work interesting because it shows that empathy can appear even in seriously awkward and artificial social interactions. So maybe a Skype chat or instant message with a knowledgeable doctor would offer more than the symptom/diagnosis/prescription information you can get on WebMD. It’s a human connection.

If it means, in this resource-strapped era, that more patients will have access to good care, and that good doctors will be able to spend more time with their patients, then let’s bring on the virtual doctors.

*

Photo by Intel Free Press